A mixed methods analysis of empowerment and satisfaction in parents of children with disabilities receiving outpatient rehabilitation

The purpose of this study was to examine the perspectives of parents of children with disabilities on family-centered care, family empowerment, and satisfaction of care in North Texas outpatient clinics using an explanatory sequential mixed methods design. In the quantitative phase, parents (a) rated the extent of family-centered care provided by their child’s service provider using the Measure of Processes of Care (MPOC-20), (b) completed the Family Empowerment Scale as a measure of their perceptions of their empowerment levels, and (c) assessed their overall satisfaction with services using the Client Satisfaction Questionnaire (CSQ-8). Three separate multiple regressions examined if any of the five domains of the MPOC-20 predicted empowerment at the family level, empowerment at the service system level, and satisfaction of care. Using maximum variation sampling, a subset of the subjects was selected to participate in the qualitative phase where semi-structured interviews were conducted to explore specific behaviors of service providers that contribute to empowerment and satisfaction of care. Survey response rate was 35.6%. Quantitative data analysis found family-level empowerment was predicted by two factors: providing general and specific information. Similarly, service system level empowerment was predicted by providing general and specific information, with the addition of coordinated and comprehensive care. Satisfaction of care was predicted by two factors: providing specific information and respectful and supportive care. Qualitative interviews revealed service providers offering knowledge, skills, resources, and emotional support to mothers appear to be a catalyst for the process of empowerment. Satisfaction of care was impacted by three factors relating to (a) child, (b) structure including the setting and environment, and (c) service provider (connection, communication, commitment). Service providers offering mothers individualized knowledge of their children and activities, and providing emotional support were the common behaviors that led to both empowerment and satisfaction of care. Service providers need to effectively communicate individualized knowledge of the child and activities and have adequate interpersonal skills to create a supportive environment for mothers. Pediatric health care organizations can utilize this information to advance a family-centered environment by tackling any identified system level barriers to providing family-centered care.